Abstract
BackgroundVoiding dysfunctions are common complications afterrectal cancer resection, secondary to injury to the auto-nomic nervous plexus. In locally advanced rectal cancernervous damage can be necessary in order to obtaincurative resection. However, the development of a newsurgical technique such as Total Mesorectal Excision,nerve sparing dissection (and about multivisceral resec-tions bladder- sparing operations) and greater under-standing of the regional anatomy has improved survivaland decreased voiding and sexual dysfunction rates [1].Material and methodsBetween January and December 2003, 35 patients under-went surgery for colorectal cancer (10 left hemicolectomies21 anterior resections and 4 abdomino-perineal resections).All patients underwent multichannel urodynamic evalua-tion. The data collected were: bladder capacity and compli-ance, sensitivity and contractility, and obstruction outlet.ResultsTwelve months after surgery, urodynamic alterationswere found in 14 patients (40%); the most frequent pat-terns were detrusor overactivity (4 pts), vesico-sphincterdyssynergia (5 pts) and neurogenic bladder (2 pts).However, in six patients (5 of left hemicolectomygroup and 1 of Miles’ group) obstruction outlet due tobenign prostatic hypertrophy was discovered.ConclusionsThe optimal way to objectively describe urinary dysfunc-tions is by careful urologic history and urodynamicinvestigation before and after the operation.In males over the age of 65, minimal neural damageduring surgery may complicate any pre-existing blad-der outlet obstruction from benign prostatic hyper-trophy [2].Laparoscopic rectal resection doesn’t adversely affectbladder function, but isn’t indicated for local rectalcancer [3]. Bladder dysfunction after colorectal surgerycan be avoided by identifying and preserving the pelvicautonomic nerves, according to oncologic radicality inperforming total mesorectal excision and, if possible,preferring bladder-sparing surgery respect to pelvect-omy [4].
Highlights
Voiding dysfunctions are common complications after rectal cancer resection, secondary to injury to the autonomic nervous plexus
Twelve months after surgery, urodynamic alterations were found in 14 patients (40%); the most frequent patterns were detrusor overactivity (4 pts), vesico-sphincter dyssynergia (5 pts) and neurogenic bladder (2 pts)
The optimal way to objectively describe urinary dysfunctions is by careful urologic history and urodynamic investigation before and after the operation
Summary
Voiding dysfunctions are common complications after rectal cancer resection, secondary to injury to the autonomic nervous plexus. In locally advanced rectal cancer nervous damage can be necessary in order to obtain curative resection. The development of a new surgical technique such as Total Mesorectal Excision, nerve sparing dissection (and about multivisceral resections bladder- sparing operations) and greater understanding of the regional anatomy has improved survival and decreased voiding and sexual dysfunction rates [1]
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